Dislocations

Relocation of a joint is very important to decrease the incidence of long-term disability and morbidity. Even with immediate attention and reduction, there may be damage of articular cartilage, joint capsule, ligaments, or neurovascular structures. These factors lead to increased incidence of ectopic ossification, post-traumatic arthritis, and avascular necrosis. The amount of time from injury until relocation directly correlates with outcome. This point is exemplified in the hip where the incidence of avascular necrosis is 17.6% when reduced within 12 hours compared with 56.9% when reduced after 12 hours.3

In the trauma setting, dislocations are most frequently seen in the hip but can also involve shoulder, elbow, wrist, knee, patella, and ankle. Acute dislocations of the knee are especially correlated with vascular injury and an arteriogram should be considered after relocation even in the presence of good pulses.

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